SOM & FGP Compliance Office: Helping Docs Navigate Those Billing Issues

05/03/11 - Life at NYULMC

Are you a provider in a Faculty Group Practice (FGP)? How can you be sure you’re complying with proper billing practices?   

The School of Medicine and Faculty Group Practice Compliance Office provide physicians and administrative staff with compliance oversight and support on physician billing practices. The goal is to eliminate any coding and billing errors to reduce the risk of any possible allegations of fraud, to provide training and education, and to identify systems that can be added or changed to improve physician billing practices.  

As such, the office conducts retrospective chart audits for each billing provider within the Faculty Group Practice (FGP). The purpose of this audit function is to:

• assess compliance with federal and state billing regulations,
• identify any billing, coding and documentation needs for training and education,
• identify missed revenue opportunities, and
• assist the FGP practices with external reviews being carried out by government agencies (e.g., CMS, OIG, OMIG) and other third party payors

 Compliance Risk

An audit results in one of three levels of risk: Unacceptable, Area of Concern, or Acceptable. 

• “Unacceptable” indicates a compliance risk of greater than 30%. Providers with audit results in this range will receive focused training by a senior compliance specialist and will be re-audited within one month after the training.
• “Area of Concern” indicates a compliance risk of 11-30%. Providers with audit results in this range will also receive focused training, and will be re-audited within 3-6 months of the training.
• “Acceptable” indicates a compliance risk of less than 10%. Providers with acceptable compliance risks are re-audited annually. 

Training & Education 

In addition to the specific training and education the office provides in connection with the chart audits, the SOM/FGP Compliance Office offers billing compliance orientation for new providers and employees. This training focuses on Evaluation and Management (E/M) coding and documentation, the Teaching Physician rules, Incident-to/Split-Shared Visits, use of modifiers and other topics specific to physician billing practices.